Resistant Hypertension: High Cortisol Levels Found in 27% of Patients – New Study

For residents of Austin, Texas, struggling with stubbornly high blood pressure, a recent national study offers a potentially crucial insight. The MOMENTUM study, released this week, suggests that an often-overlooked hormonal imbalance – hypercortisolism, or excess cortisol – could be a significant and treatable, contributor to resistant hypertension in nearly a third of those affected. This isn’t just a national health story; it’s a call to action for anyone in the Austin area experiencing difficulty managing their blood pressure despite being on multiple medications.

Understanding Resistant Hypertension and the Cortisol Connection

Resistant hypertension, defined as blood pressure remaining elevated even with three or more medications, including a diuretic, impacts roughly 13% of individuals with hypertension. In the United States, that translates to nearly 10 million people. Here in Austin, with its rapidly growing population and active lifestyle, the prevalence of hypertension is a growing concern for healthcare providers at institutions like St. David’s Medical Center and Ascension Seton Medical Center. What’s becoming increasingly clear is that for a substantial portion of these patients, standard treatments aren’t enough, hinting at underlying causes that need to be addressed.

Cortisol, often dubbed the “stress hormone,” plays a vital role in regulating the body’s response to stress. Yet, chronically elevated cortisol levels can wreak havoc on the cardiovascular system. It impacts blood pressure through several pathways, including activation of the renin-angiotensin-aldosterone system (RAAS), stimulation of mineralocorticoid receptors, impaired vasodilation, and heightened sympathetic nervous system activity. These effects significantly increase the risk of serious complications like myocardial infarction, stroke, and heart failure – risks that are particularly concerning given the active, outdoor lifestyle many Austinites enjoy.

The MOMENTUM Study: A Landmark Investigation

The MOMENTUM study, the first large-scale, prospective US-based investigation into hypercortisolism prevalence in resistant hypertension, screened 1,086 patients at 50 sites nationwide. Researchers utilized the 1-mg overnight dexamethasone suppression test (DST) to assess cortisol levels. The results were striking: 27.3% of patients with resistant hypertension exhibited hypercortisolism. This finding dramatically shifts our understanding of the condition, suggesting it’s far more common than previously believed.

The study also revealed that patients with hypercortisolism experienced significantly worse kidney function and a higher rate of chronic kidney disease (CKD) progression. Given the increasing rates of diabetes and kidney disease in Texas, this connection is particularly relevant for the Austin community. Markers of primary hyperaldosteronism were present in approximately 20% of participants, with 6% demonstrating cortisol-aldosterone co-secretion, indicating a complex interplay of hormonal imbalances.

What Does This Signify for Austin Residents?

The implications of the MOMENTUM study for Austin residents with resistant hypertension are significant. For too long, hypercortisolism has been considered a rare cause of high blood pressure. This study demonstrates that it’s a common enough occurrence that it warrants consideration in the diagnostic process. The good news is that hypercortisolism is often treatable, offering a potential pathway to better blood pressure control and reduced cardiovascular risk.

Dr. Deepak L. Bhatt, MD, MPH, MBA, a paid consultant for Corcept Therapeutics Incorporated (the study sponsor), emphasized the importance of these findings. He noted that the high prevalence of elevated cortisol levels – over 25% – is a departure from traditional medical training and should prompt increased screening for excess cortisol in patients with resistant hypertension. He also highlighted the need for randomized trials to determine if therapies targeting cortisol can safely and effectively lower blood pressure in these patients.

Beyond Blood Pressure: The Wider Health Impact

The impact of hypercortisolism extends beyond blood pressure control. Elevated cortisol levels are linked to a range of health problems, including weight gain, muscle loss, and diabetes. These are all conditions that are increasingly prevalent in Austin, contributing to the overall burden of chronic disease. Addressing hypercortisolism could therefore have broader health benefits, improving overall well-being and quality of life for individuals in the community.

Navigating the Next Steps: A Local Resource Guide

Given my background in preventative cardiology and public health, and understanding the unique healthcare landscape of Austin, Texas, if you’re experiencing resistant hypertension, here are three types of local professionals you should consider consulting:

Endocrinologists specializing in adrenal disorders:

Look for a board-certified endocrinologist with specific experience in diagnosing and treating conditions affecting the adrenal glands, such as hypercortisolism and hyperaldosteronism. Experience with the dexamethasone suppression test and other hormonal assessments is crucial. Many excellent endocrinologists practice at the Dell Medical School at the University of Texas at Austin.

Nephrologists focused on resistant hypertension:

Since the MOMENTUM study highlighted a link between hypercortisolism and kidney function, a nephrologist specializing in resistant hypertension can provide valuable insights. They can assess your kidney health, identify potential contributing factors, and coordinate care with other specialists. Consider seeking a nephrologist affiliated with Baylor Scott & White Medical Center – Austin.

Cardiologists with expertise in secondary hypertension:

A cardiologist experienced in secondary hypertension – high blood pressure caused by an underlying medical condition – can help determine if a hormonal imbalance is contributing to your resistant hypertension. They can also assess your overall cardiovascular risk and recommend appropriate treatment strategies. Look for a cardiologist practicing at the Texas Heart Institute at St. Luke’s Medical Center.

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